
Class ^L^/ 
Book f66 



THE GREAT WHITE PLAGUE 



*■*"* 



SIMPLE 
LESSONS ON 
I CAUSES AND 

I PREVENTION 




BY 



W. D. FROST and M. V. O'SHEA 



ISSUED BY 



C. P. CA-RY, STATE SUPERINTENDENT 




MADISON, WISCONSIN 

Democrat Printing Company, State Printer 

1912 



It 



/ 



7 '< 



BACILLUS TUBERCULOSIS. 





«?V v • 



The germs of tuberculosis from the spit of a consumptive as 
they appear under the highest powers of a compound microscope. 
Each little red rod is a separate individual and capable of pro- 
ducing the disease under favorable conditions. 



The Great White Plague 



Simple Lessons on Causes and 
Prevention 



INTENDED ESPECIALLY FOR USE IN SCHOOLS 



BY 

W. D. FROST 

of the Department of Bacteriology 

AND 

M. V. O'SHEA 

of the Department of Education 

IN THE UNIVERSITY OF WISCONSIN 



ISSUED BY 

C. P. CARY 

STATE SUPERINTENDENT 




MADISON 
Democrat Printing Company, State Printer 

1912 






Copyright, 1912, by 

W. D. FROST and M. V. O'SHEA 

• Madison, Wis. 



JUL 1 '91? 



TABLE OF CONTENTS. 



Page 

Lesson I. Minute Forms of Life 5 

Lesson II. The Work of Microbes 8 

Lesson III. Microbes Produce Disease 10 

Lesson IV. The Germ of Tuberculosis 12 

Lesson V. The Nature of Tuberculosis 15 

Lesson VI. The Extent of Tuberculosis 17 

Lesson VII. The Spread of Tuberculosis 22 

Lesson VIII. Means of Preventing Tuberculosis 26 

Lesson IX. Means of Preventing Tuberculosis (Concluded) 30 

Lesson X. Developing Resistance to Disease 38 

Lesson XI. Tuberculosis a Curable Disease 45 



PEEFACE 



This little book is intended for pupils from the age of twelve 
or thirteen years onward. It has been the aim to make the 
material contained in it of practical interest to teachers as well 
as to pupils. The treatment throughout is simple and concrete, 
and every principle developed is illustrated with instances drawn 
from the every-day experiences of children of the ages for whom 
the book has been prepared. Generous use has been made of 
photographs and diagrammatic pictures. 

If the pupils now in the schools could be so instructed in re- 
spect to the subject matter of this book that it would take effect 
in their daily living, tuberculosis would be materially dimin- 
ished immediately; and in a generation or two it would prob- 
ably disappear completely. It is doubtful if it can be got rid 
of in any other way. 

The authors have had the co-operation of the Wisconsin Anti- 
Tuberculosis Association in the preparation of the book; and 
acknowledgment is hereby made of valuable financial help as 
well as criticisms and suggestions made by the officers of the 
Association. Acknowledgment is also made of assistance re- 
ceived from Superintendent C. P. Cary, and from Professor 
W. E. Leonard, Miss M. E. Ashmun and Mrs. E. E. Hoyt of the 
University of Wisconsin. 

Madison; Wis., March, 1912. 

The Authors. 






THE GBEAT WHITE PLAGCTE. 



Lesson I. MINUTE FORMS OF LIFE. 

You have all seen India ink, and you know how black it is ; 
but do you know that its blackness is due to very fine particles of 
the ink so small that they cannot be seen with the naked eye? 
When they are seen under the microscope they look like pieces 
of coal. 

We cannot see the moisture in the atmosphere, and yet we 
know it is there, else we could have no "rain or snow. 

Although everyone is familiar with many kinds of plants and 
animals differing as to size, some people do not realize that there 
are a great many forms of life so small that they cannot be seen 
with the naked eye. 

Mention all the forms of life you know which are so small 
that you cannot see the individuals, although you can observe 
masses of them when they multiply into billions. How can you 
tell that there are individuals in these masses? You should 
make a few experiments to show that there are very minute living 
things that will do work which we can observe when the condi- 
tions are right. 

In an ordinary compressed yeast cake there are billions of 
living cells, or plants, that are called yeast plants. These cells are 
so small that we cannot see the individuals without a microscope, 
but we can see the work which masses of them do working to- 
gether. Everyone is familiar with the "raising" of bread when 
yeast is put into it. Anyone can show the working of yeast by 
putting a few teaspoonfuls of sugar into a tumbler of warm 
water — just warm enough to hold the finger in — and then 
crumbling into this a considerable portion of a compressed yeast 
cake. In a little while, the yeast cells or plants will begin to 
work, and soon gas will be seen escaping, with the appearance of 
a frothy scum on the surface. These changes are due to the activ- 



6 Tuberculosis: or The Great White Plague. 

ity of the yeast cells, which break up the sugar, forming alchohol 
and carbonic acid gas. It is this gas which we see rising in 
bubbles. 

Minute, invisible forms of life exist everywhere about us. 
They are so small that they cannot be seen by the naked eye, 
but if they fall upon a suitable food such as the cut surface of a 
boiled potato, or a slice of moist bread or cheese, they will in- 
crease in number so rapidly that in a few days they will form 
spots or " colonies" which are easily visible. The air always con- 
tains a greater or smaller number of these invisible forms of life, 
but, fortunately, they are usually not harmful. 




E'k 



-Yeast cells as seen under a very power- 
ful microscope. 



Have you observed what happens to meat, milk, or almost any 
other article of food, if it is left exposed to warm, moist air? 
Describe what happens. Why do people boil milk to keep it from 
' ' spoiling ? ' ' Why will cooked meat keep longer than raw meat? 
Why do people, when they can cherries, pears, or other fruits, 
try to make the cans air-tight ? What will happen if they do not 
do so? 

Our forefathers from remote times until a few decades ago lived 
without having clearly understood that there are vast num- 
bers of both plants and animals so minute that one can see them 
only with the aid of a powerful magnifying glass. But when the 
microscope was perfected, people began to understand that there 
is a world of living things of which many have never even dream- 



Simple Lessons on Causes and Prevention. 7 

ed. Some one has spoken of this newly discovered world as that 
of the "infinitely little." And as we have come to know more 
about these microscopic plants and animals, we have come to real- 
ize how important they are. They do much of our work, such as 
preparing our food, carrying off and destroying our waste mat- 
erial, and performing other necessary and useful tasks. Some of 
them are our friends. They ripen our cream for butter-making, 
cure our cheese, make our vinegar; they purify our sewage and 
disintegrate our garbage ; they keep the soil fertile, etc. Many of 
them, however, are our enemies ; and the fact that they produce 
diseases of different sorts is one reason why we have become so 
much interested in them, and why we are trying to discover 
under what conditions they grow, and how we can control them. 
The forms of life we are to study about are altogether too 
small to see without the help of a large and expensive micro- 
scope ; and unless we can use this instrument, the only way in 
which we can learn anything about these minute bodies is to 
observe the work which they do. 



8 Tuberculosis: or The Great White Plague. 



Lesson II. THE WORK OF MICROBES. 

Bring from your home, or secure from a grocery store, a rotten 
apple and a rotten potato, and also a few sound ones of each va- 
riety. Your teacher will then place the rotten apple on a table or 
shelf, and, close to it and touching it, a sound apple. Place an- 
other sound apple near the diseased one, but not touching it. 
Wrap another apple in a piece of paper (waxed paper, if you can 
get it), and put this so that the paper touches the rotten 
apple. Do the same thing with the potato and note what hap- 
pens. 

You will need to make observations in this experiment for about 
one week. After this time, describe what has happened to the 
apple or potato in contact with the rotten ones. Has the same 
thing happened to the one near but not touching the rotten one ? 
Has the paper served as a means of protecting the apple or 
potato from decay? What does this experiment show in regard 
to the way in which decay in fruit and vegetables is spread? 
Is decay catching? Why? 

Secure some moldy fruit or vegetable, or a piece of moldy 
cheese, and allow it to dry so that it can be pulverized. Then 
take some fresh bread and cut several slices. This latter work 
ought to be done in a separate place from that in which the moldy 
food is handled; it ought also to be done by a different person 
from the one who prepares the molds. Why ? Place each of three 
slices of the fresh bread on a sheet of blotting paper, and on two 
pieces of the bread sprinkle a small quantity of the mold dust. 
Cover one of these with a glass bowl, or some other glass dish. 
The third "unseeded" piece should also be covered with a glass. 
Those pieces which are covered should be kept moist by placing 
water on the blotter from time to time. Keep track of develop- 
ments for a few days. At the end of this period describe what 
change has taken place on the uncovered piece of bread. What 
was the object in covering the bread ? Note that the molds do not 
grow unless they have been seeded. If a few molds do grow on 
the third piece of bread, it simply means that the mold ' ' seeds ' ' 
or "spores" fell on it from the air before it was covered; note 



Simple Lessons on Causes and Prevention. 9 

alsq that of the two pieces of bread seeded with mold, only the 
one that was kept moist developed a heavy crop.* 

Many kinds of microbes, or tiny invisible forms of life, do a 
great deal of good for us, and it would be quite impossible, or 
at least very inconvenient, to get along without them. But mi- 
crobes are known chiefly for the harm they do, since in many 
ways they interfere with cur happiness. The decay of fruit, 
vegetables, and other food products is an undesirable change 
which microbes produce, ancl with which we are all familiar 
You have already seen the experiments with a rotten apple or 
potato. If we suffered the loss of a single apple or potato occa- 
sionally we should not mind it much ; but in our experiment we 
discovered that when one apple becomes diseased, the perfectly 
sound apples around it will soon decay, first on the side which is 
in contact w T ith the bad apple, and then all the way through. We 
know very well that if we leave a decayed apple in a basket or 
barrel, it will not be a very long time before all the neighboring 
apples will become diseased. The microbes which produce these 
changes pass directly from one apple to another when the apples 
touch. The same thing is true of potatoes; whenever we find a 
rotten potato in the bin, we always throw it out to prevent the 
rottenness from spreading. 

In somewhat the same way that microbes produce decay and 
rottenness in fruits and vegetables special sorts of microbes 
produce diseases in man and animals. We have heard of "con- 
tagious" or "catching" diseases. We know that a person Avho 
has smallpox, measles, or whooping cough is being attacked by 
microbes, and just as microbes may pass from one apple to an- 
other in a barrel, so smallpox, measles, and scarlet fever may pass 
from one person to another, or from the sick to the well. 

Have you ever seen a house with a colored placard on the door 
bearing the words "Scarlet Fever," or "Diphtheria," or "Small- 
pox ? ' ' Why was the placard placed en the house ? Could people 
come and go in that house as they chose ? Why? 



* In explaining why these things are true the teacher can bring out 
the importance of environmental conditions, such as, eir space, 
amount of light, moisture and dust. 



10 



Tuberculosis: or The Great White Plague. 



Lesson III. MICROBES PRODUCE DISEASE. 



In a good many cases we do not know how the "germs" or 
microbes of disease pass from one person to another. But we do 
know that in some way, whether by way of the mouth, or the nose, 

or the skin, they do leave the 
sick body and in some man- 
ner, either through the air we 
breathe, or the food we eat, or 
through the skin, they do en- 
ter the bodies of healthy peo- 
ple. Diseases of this kind are 
spoken of as "infectious" or 
"contagious" diseases. They 
are produced by microbes, 
without which they would not 
exist. 

Microbes produce disease 
in man and animals in two 
different ways. One class 
grows in our food materials 
and produces poison. When 
these poisons are taken into 
the stomach with food, they 
may produce sickness or 
even death. These poisons 
are known as "ptomaines." Instances of "ptomaine poisoning 
are frequently noticed in the newspapers. The dangers of pto- 
maine poisoning can be avoided by protecting food materials, 
especially meats, from the growth in them of the "putrefaction" 
or decay microbes or "bacteria." 

Microbes, however, usually produce disease in man and animals 
by growing in the body of their victim. They live upon the ma- 
terial of which the body is made. From this flesh and blood they 
make poisons which cause sickness and death. These microbes 
are "parasites." (What is a parasite?) Diseases caused in this 
way are spoken of as "germ" diseases. To these diseases, also, the 
terms "contagious," "infectious," and "preventable" are given 
for reasons to be explained later. 




Fig. 2. — Pasteur — One of the greatest 
benefactors of the human race. He 
said "It is within the power of man 
to make the germ diseases disappear 
from the world." 



Simple Lessons on Causes and Prevention. 11 

A particular germ is always the cause of a particular disease. 
These germs are usually named after the diseases which they pro- 
duce, as the "diphtheria" germ, the "typhoid" germ, or the 
' ' tuberculosis ' ' germ. People never have these diseases unless the 
particular germ which causes them is growing in and poisoning 
the body. The disease germs always come from parent germs, and 
never start from "nothing' ' as some people used to think ; or from 
the body itself. These germs always come from some previous 
case of the disease which they produce. Certain of these diseases 
are "caught" by one's coming into contact with some one having 
the disease. For this reason they are called "contagious" 
(touched; carried). Decay or rottenness in fruit or vegetables 
is produced in the same way, you will remember. Some other 
germ diseases are carried indirectly from the sick to the healthy ; 
as, for example, through food or drink, as milk or water; and 
by means of insects, as flies and mosquitoes. These are called 
"infectious" diseases. There is no sharp distinction between in 
fectious and contagious diseases. All contagious diseases are in- 
fectious, but infectious diseases are not necessarily contagious. 
Why? 

Probably all of these diseases can be prevented. All that is 
necessary is to prevent the escape of the disease germ from those 
infected by it, and guard the bodies of the well from its attack. 

Among the diseases produced by microbes none is more impor- 
tant or dreadful than "tuberculosis.'^ The presence of tubercu 
losis in a family or community is dangerous, in somewhat the 
same way that a rotten apple in a basket is dangerous to all the 
good apples. But there is this difference : it is practically impos- 
sibe to make a rotten apple safe to put with the sound ones. But 
in the case of tuberculosis and other diseases due to microbes or 
germs, when intelligent care is used, people suffering from them 
may with a certain degree of safety mingle with well people. But 
it must always be remembered that a person suffering from a 
germ disease is dangerous to the people around him unless every- 
body is very careful to prevent the escape of the dangerous 
germs from the diseased person, and the entrance of these germs 
into the body of some one else. 



12 



Tuberculosis : or The Great White Plague. 



Lesson IV. THE GERM OF TUBERCULOSIS. 



Expose a gelatine or agar plate* to the air for a few minutes, 
then cover it up, and allow it to grow for several days. Growths 
will appear in the form of " colonies. " Each colony represents 

the decendants cf a single 
germ which fell on the plate. 
Count the number of colo- 
nies, and, knowing the area 
of the plate and the number 
of minutes it was exposed 
figure out the number 
of bacteria that were falling 
in the room per square foot 
per hour.f Draw some of the 
colonies. If possible, exam- 
ine some of these germs or 
mircobes or bacteria under 
the microscope, and draw 
what you see. Perhaps your 
teacher will give you one of 
these plates to expose at 
home. When the colonies 
have grown out, count them 
and then examine them under the microscope. 

Until late years nothing was known in regard to the cause of 
tuberculosis. It was only about the middle of the last century 
that the disease was definitely considered as an infectious dis- 
ease. Our ancestors thought that it was due entirely to "hered- 
ity;" that is, that children were born with it. The credit of 
discovering the cause of tuberculosis belongs to Robert Koch, of 
Germany. The discovery was announced in 1882. At the time 
Robert Koch made his discovery, scientists were just becoming 




Fig. 3. — Robert Koch — This picture 
was taken of him at about the time 
he discovered the "tubercle bacillus." 



* These cannot be prepared except by those' who have had special 
training in bacteriology, but the necessary material will be furnished 
for this experiment, accompanied by full directions for use. These 
experiments add much to the interest of the work. Write' to the De- 
partment of Bacteriology and Hygiene, University of Wisconsin. 

t For example, if the plate has an area of 12 square inches and de- 
velops 20 colonies when exposed 20 minutes the rate of falling would 
be 12 times 20 or 240 per foot each 20 minutes, or 3 x 240, or 720 
per hour. 



Simple Lessons on Causes and Prevention. 13 

acquainted with the various disease germs or "bacteria." Bac- 
teria, as you have learned, are forms of plant life in which the 
individuals are so extremely small, that they are invisible. In 
measuring them we use, as the unit of measurement, what is 
known as a micron, which is about 1/25000 of an inch. Many of 
the bacteria are only about one micron in length, and rarely are 
they more than a micron in width. This means that 250 of such 
bacteria placed end to end would about equal the thickness of a 
piece of the paper on which this book is printed. 

Different bacteria vary in shape, from spheres through the 
cylindrical forms, to twisted cylinders, or corkscrew forms. 
The "bacillus" or germ of tuberculosis is a straight, narrow 
rod, about half a micron wide, and five or six microns long. 
Many kinds of bacteria can be grown artificially on food sub- 
stances made from meat. A broth made very much like a beef 
consomme is frequently used. To this may be added a gelatine or 
agar (a vegetable gelatine), and in these substances, or media, 
as the scientists say, most bacteria grow readily. The bacillus 
of tuberculosis, however, is a very dainty microbe, and it will 
not grow in the media named above unless a little glycerine is 
added, in which case it grows well, but slowly. It grows very 
well upon the fluid or watery part of blood, either human of 
animal, which has been hardened by heat. Except when intro- 
duced into such media as just mentioned above, the "tubercle 
bacillus" does not grow outside of the animal body. This is 
very fortunate for us, because, if it did increase in numbers 
outside of the body, the whole world of men and animals wouh 
have been affected long before this. 

The tubercle bacilli, or germs of tuberculosis, which come 
directly from a sick patient, or from "cultures" made in the 
way described above, where it was shown how to grow bacteria 
at will, can be studied only under the microscope. 

Because they are extremely small, and also because they 
are' almost transparent and without color, it is very difficult to 
study them. Ordinarily they are examined only when they 
have been specially treated or stained. When they are viewed 
under the miscroscope, they present a characteristic appearance. 
The fact that the tubercle bacillus takes a stain of its own, 
makes it possible for those trained to the task to tell this germ 
from all others which may be somewhat like it. The sputum 
(or spit) of a person who has tuberculosis contains these germs, 



14 



Tuberculosis: or The Great White Plague. 



sometimes in very great numbers. By staining this material 
and examining it under the miscroscope, it is usually possible 
to early find the germ of tuberculosis. Everyone who suspects 
that the disease may have fastened itself upon him should have 
his sputum examined. Many states, and some of the cities of 
the country, have dispensaries or laboratories where this kind 
of work is done without charge. 

Although the germ of tuberculosis does not grow and repro- 
duce outside of the body, except on special "culture media,' ' 
still it does live outside the body sometimes for very long periods, 
simply retaining its vitality, ready to grow when the conditions 
are right. This germ can withstand drying for months and even 
years. It may live in putrefying (rotting) or decaying material 
for a long time, and in dark, dirty corners of buildings for years. 
One of the best ways of killing it is to allow the direct sunlight 
to reach it. It will be killed also more quickly in a dry than in 
a mcist place. Hence, the necessity of dry, well-ventilated, 
and light rooms. 




Jl small pjrticlr of Spvium aee/i 
Ihrough theMcros<ope- TfteRtdmdrfo . 
• frfirestett the Tvbsrxulcsia Germ* to.ooo 

</m« ,rt»r S «rf ... 




fTjp«c#o»fe« 



FINDING SEEDS IN 
SPUTUM OR SPIT* 




DOCTOR EXAMINING CHEST 

2UKUCT1NG SOLID P0RT10HS ^LISTENING TO SOUNDS 



AS CARPENTER SOUNDS 
JOISTS IN PLASTER WALL 



MADE BY" AIR IN 
THE LUNGS 



CHEST MUST BE BARE? 



Fig. 4. — The germ of tuberculosis. See Fig 5 —Doctor examining the chest of 
last page of cover. a person suspected of having tuber- 

culosis. 



Simple Lessons on Causes and Prevention. 



15 



Lesson V. THE NATURE OF TUBERCULOSIS. 

Nearly everyone has seen people' who were thin, with hollow 
cheeks and narrow chests, and who had a dry, hacking cough. 
Such people are sometimes said to be suffering from "bron- 
chitis;" but if the truth is known, it sooner or later appears 
that they have consumption, or tuberculosis of the lungs. 
There are few people who have not seen hunchbacks. These 
people have deformed spinal columns which have been injured 
and twisted on account of a diseased condition. This is usually 
the result of tuberculosis. Hip joint disease is common. On 
account of disease, the hip has been deformed, and the hip 
joint stiffened so that it can not be moved.. If we knew the 
history of these cases, we should find that almost always this 
injury to the hip joint had been brought about by tuberculosis 
Diseases of the bones in other parts of the body are frequently 
caused by tuberculosis. Frequently, especially in children, dis- 
eases of the intestines, which are serious and difficult to treat, 
are caused by tuberculosis. 

We have already noticed that tuberculosis is a disease caused 
by the growth in the body of a germ or microbe knoAvn as the 




Fig. C>. — The little bunches or "nodules" are the "tubercles" 
formed on the inside of a cow with tuberculosis, In health 
this "omentum" is smooth. 



16 Tuberculosis: or The Great White Plague. 

Bacillus tuberculosis. When the germ gets into the body, it 
grows in the tissue, destroying the cells all around it. It also 
makes certain other cells grow causing the production of "nod- 
ules" or "tubercles." These are shown in the accompanying 
illustration. This formation of "tubercles" is peculiar to this 
disease, and has given it the name tuberculosis. Ihis germ 
may grow in any part of the body; but in human beings it grows 
most frequently in the lungs. When tuberculosis occurs in the 
lungs, and especially after the disease has gone on for some 
time, it is known as consumption. In the United States, about 
nine people die of consumption, where one dies from some 
other form of tuberculosis ; so that consumption is by far the 
most important form of this disease. A great many people 
suffer from various other forms of the disease, however; and 
children especially are likely to have the disease in the intes- 
tines, or in the spinal column, or in the hip joint or other bones, 
or in the glands of the neck and so on. In times past, these 
diseases went under different names, but whether the tubercle 
bacillus attacks the parts of the body named above, or the brain, 
the spinal cord, or any other part, it is in reality one and the 
same disease, and is caused by the same microbe. 



CILLTOdRM 




VOLUNTEERSWANTED- 
M EN, WOMEN, CHILDREN. 

Fig. 7. —The appeal is to all of us. 



Simple Lessons on Causes and Prevention. 



17 



Lesson VI. THE EXTENT OF TUBERCULOSIS. 

What is the most frequent cause of sickness and death? 
This is a question any one might well ask. If you were to go 
to the health officer in your city or town, and ask him what 
was the chief cause of death in your community, the reply would 
ordinarily be, "Tuberculosis." If your health officer had a 
record of the living cases of tuberculosis, as he certainly ought 
to have, he would tell you that there are far more cases of 
tuberculosis than of any other disease; and at any one time 
there would probably be more cases of tuberculosis than there' 
were cases of all other infectious or germ diseases together. 
So that it is fair to say that tuberculosis is the greatest 
plague with which the human race is afflicted, because of all 
diseases common to mankind, it is the most widespread and 





(0 




03 




o 


0) 


3 


m 


o 


CD 


^ 




Q) 


— 


JS 




£ 



6333~ Scarlet Fever 

12,866 
Measles 



35,379 

Typhoid Fever 



I6,4Z5 
Diphtheric? 

9,958 
Whooping Cough 

16,645 
Influenza 



Fig. S. — This figure shows that tuberculosis is more deadly than scar- 
let fever, measles, typhoid fever, diphtheria, whooping cough and 
influenza combined. U. S. Census Report. 



18 



Tuberculosis: or The Great White Plague. 



the most deadly. John Bunyan spoke of it as the "Captain of 
the Men of Death." It causes more deaths each year than 
scarlet fever, measles, typhoid fever, diphtheria, whooping 
cough, and influenza combined. Study the chart and see how 
this fact is shown. We think of the terrible loss of life due -o 
war, but tuberculosis kills many more people than war ever has 
done ; and it always keeps on with its work. It never grants a 
truce. The entire loss of life in the Franco-Prussian war was 
only about one-half the loss from tuberculosis in Prussia alone 
for a single year. The loss of life in our country, due to tuber- 
culosis, in any four years, is about three times the loss of men 
during the four years of the Civil War. 

In the nineteenth century there were many terrible wars, 
and it is estimated that fourteen million soldiers died on the 
battle field. But while these wars were going on, thirty mil- 



COMPARISON 

OF 

Deaths rROM QvhWar 

tv/r/f 

\ DEATH J ffiOAf CONSUMPrW 

United States 
Owl War -FQurYearj 

^ tssi- tacs- 

K/iteo in Action 

A*SO 

O/EO mew WOUHOS. 
FEDERAL - -HO OOO 
i CONFEDERATE - 35 OOO 
TOTAL - - ■ 205000 
\CONSUMPTION 
FOUR YEARS. 
/904/901 
644.00O. 



6^.0 09d 



sosooo 



Fig. 9. — The banded object, at 
the left, represents a germ 
of tuberculosis. It appears 
more than three times as 
long as the gun and this 
represents the relative de- 
structiveness of this germ 
as compared with the gun 
in war time. We must re- 
member that this germ is 
destroying its victims all 
of the time, and not merely 
during war time. 





WISCONSIN! 




NATIONAL GUARD 
I STRENGTH 2726 



I2500WICTIMS OF 

'■■'■-"• V TVBERCUL05IS 



Fig. 10. — About as many people die in 
Wisconsin each year from tuberculo- 
sis as there are soldiers in the State 
Guard. There are at least six times 
as many living cases, probably ten 
times. 



Simple Lessons on Causes and Prevention, 



19 



lion people in the very same countries died of tuberculosis. The 
number of deaths in the San Francisco earthquake was only a 
little over one half of the loss of life every year in San Francisco 
from tuberculosis. The great earthquake in Southern Italy 

Cost o/= TUBEFfCULOS/S '//y t/~/e U/y/ted States cowFAftED 
with V<\eue or \A/=?/ous Staf^^e F'/fooucrs. 



Tuberculosis 

Corn 

Animals Sold 

\~\aij -Forage 

Milk-Bufter-& 

Whe^t 

Cotton 




464,254,703 



472,276,703 



369,9/45,320 



323,756,171 



Oits 



Forest Products 




To ba ceo 
Small Fruit 



217,098,554 



09, S64, 770- 



H 56,989,902 
| 25,029,757 



Fig. 11. — The length of the lines indicates what tuberculosis annually costs the 
people of the United States in dollars in comparison with the value of vari- 
ous staple products. 

destroyed scarcely more people than die each year of this disease 
in the United States. It is estimated that from twenty-five 
hundred to three thousand people die each year in Wisconsin 
from this disease. In the United States from one hundred and 



20 



Tuberculosis: or The Great White Plague. 



fifty thousand to two hundred thousand die every year, and 
a million and a half in the world. The terrible price we 
have to pay for the neglect of this disease is impressed upon 
us if we realize the fact that of the ninety million people now 
living in the United States over nine million of them will die 
of tuberculosis, unless conditions are improved; and of these 
nine million, two hundred and fifty thousand will be in the 
State of Wisconsin. 



YEilRLY LOSSES FROM 

TUBERCULOSIS WEI BUY 




/j*3bi 






\n 


(jMCOTWHilf] [ 


POTATO 5 


A 


m 


WW > 





19,500,000 35,000,000 44,000,000 

OR OR 

BUSHELSflTSO* BUSHELS AT 504 BUSHELS AT404 






350000.CTTLE 350,000,000 40,000 MEN 

OR OR 

flT$50.PE£ HEAD LOfll/ES AT 3.05 AT %4Z7. a YEAR 

IN WISCONSIN 



Fig. 12. 

The waste in dollars and cents caused by the disease has been 
estimated by a number of people, and it is probably fair to say 
that we lose in the United States each year one billion one 
hundred million dollars ($1,100,000,000) as a result of the 
disease in human beings; and fourteen million ($14,000,000) 
more as a result of the disease in cattle. This loss far exceeds 



Simple Lessons on Causes and Prevention. 21 

the value of any one crop in the United States. Or, in other 
words, if we should lose one entire corn crop, and cotton crop, 
but could save one year's loss from tuberculosis, we should, as a 
nation, be financially Letter off than we now are. The loss of the 
dairy products, the wheat, the forest products, the tobacco, and 
small fruit of an entire year would scarcely exceed in value the 
present loss from tuberculosis. Besides the money losses in- 
dicated above, the human race has, of course, been made very 
much less happy because of the ravages of this disease than 
it otherwise would have been. It has caused poverty and suf- 
fering beyond anything that can be measured. It has been 
the direct or indirect cause of filling our insane hospitals and 
orphan asylums, our homes and hospitals for crippled children, 
our reformatories, and our prisons and penitentiaries. It has 
deprived us at an early age of many of the most brilliant men 
and women in all periods of the World's progress. 



If we had through the misfortunes of war, or the sudden 
rise of pestilence, or through some awful calamity, the de- 
struction of life that annually takes place on account of ths 
spread of the white plague, we should be appalled. Mass meet- 
ings would be held in every community and demand would be 
macie that the most urgent measures should be adopted. It 
is only because we are accustomed to this waste of life that 
we can look calmly on and go about our business, paying no 
attention to this enormous death toll, which our American 
people are paying. 

— Justice Charles E. Huglies, U. 8. Supreme Court 



22 



Tuberculosis: or The Great White Plague. 



Lesson VII. THE SPREAD OF TUBERCULOSIS. 

In a preceding lesson it was shown that the' sputum (or spit) 
of persons suffering from tuberculosis of the lungs (or consump- 
tion) may, and usually does, contain the bacilli or germs of 
tuberculosis. These germs may be carried from one place to 
another through the sputum. These germs, in the case of peo- 
ple suffering from tuberculosis, leave the body almost entirely 
in the sputum. In the case of animals suffering from the 
disease, the meat and milk may contain the bacilli, and hence 





Fig. 13. — The germs that attack us 
come from the bodies of the sick. 
From Ritchie's Hygiene, published by 
the World Book Co. 



Fig. 14. — Kiss the baby on the 
cheek, not on the mouth. Why? 
From Ritchie's Hygiene pub- 
lished by the World Book Co. 



be the means of spreading the disease. In the case of both 
man and animals, "pus," or the matter coming from the tuber- 
cular sores, may serve as a means of scattering the germs. It 
is generally believed that tuberculosis is very largely passed 
on from one person to another by means of the sputum. If 
this material is not destroyed, it dries and becomes pulverized, 
and is then blown about, and may enter a well person with the 
air that is breathed. It is estimated that the sputum given off 
in twenty-four hours by a person in the last stages of the 
disease may contain as many as seven billion tubercle bacilli 



Simple Lessons on Causes and Prevention. 23 

(7,000,000,000). Considering the number of careless consump- 
tives, it is no wonder that the air in certain buildings, or local- 
ities, frequented by consumptives, is loaded with the germs. 

When one talks, but especially when one speaks forcibly, 
coughs, o,r sneezes, there is driven out from the mouth a fine 
spray, made up of tiny drops of finely divided sputum. These 
droplets contain, in the case of consumptives, the germs of 
tuberculosis; and if these are breathed in by a person inclined 




Fig. 15. — In droplets of sputum that are 
coughed out into the air, the germs 
of tuberculosis, influenza, colds and 
other respiratory diseases are found. 

towards the disease, they may take up their abode in him, and 
grow vigorously. However, the danger of this is really great 
only when one remains very near a tuberculosis patient for a 
considerable length of time. At a distance of three or four 
feet there is likely to be but slight danger of infection. From 
a consumptive, these little drops of sputum are constantly fall- 
ing on the floor and the furniture and even on food, and it is im- 
portant that this source of danger should be avoided. 

In the case of tuberculous ulcers, abscesses, etc., the discharge 
contains the germ, and must be carefully handled to prevent 
the spread of the disease. 

Cows, even when they have tuberculosis, do not usually 
cough ; hence there is little danger from their sputum. But 
the milk contains the tubercle germs, not only when the udder 
is affected, as claimed a few years ago, but also when the in- 
fection exists in other parts of the body. The United States 
Department of Agriculture has recently found that milk becomes 
infected with disease germs by getting manure in it, 

In cattle especially the disease is located in the internal organs, 
and not in the muscles ; hence the danger of infection by eating 
meat from infected animals it not so great as it otherwise might 



24 



Tuberculosis : or The Great White Plague. 



A CONSUMPTIVE 



CM Al N 




Fig. 16. — Notice the important part that the tuberculous cow plays in this 

chain. 



Simple Lessons on Causes and Prevention. 25 

be. Nevertheless, it has been shown that the germs are present 
in the meat of cattle which have had tuberculosis, and were 
it not for the fact that meat is usually cooked before it is eaten 
thus killing the germs, it would be a more important and dan- 
gerous factor than it usually is in spreading tlie disease. 

Does your city or town have an "anti-spitting' ' law" If so, 
why was the law made ? In what places is it unlawful to spit ? 
Why? Find out whether or not the law is enforced in your 
community. Do you see people spitting on the street? In 
street cars, etc. ? Copy an anti-spitting placard which you have 
seen. Tell where you saw it. 

Does your city cr town have a milk ordinance? If so, does 
it require that the cattle supplying the milk shall be tested for 
tuberculosis ? Why ? 

Try this experiment : Darken a room, and then through a 
pin hole, or other small opening, allow a beam of direct sun- 
light to enter the room. Ask some-one so to stand that he can 
cough or sneeze right against and along this beam of light. 
Then see if you can detect the fine spray of sputum which is 
given off. Find out about how far away from the body the 
droplets are thrown. Try also the experiment of holding a mir- 
ror before the face while speaking. 



26 Tuberculosis: or The Great White Plague. 



Lesson VIII. MEANS OF PREVENTING 
TUBERCULOSIS. 

As we have seen, tuberculosis is not inherited; but in al- 
most all cases it is taken by a "susceptible" person coming 
into contact with some one having the disease. The need to re- 
peat for emphasis, that if we are to prevent the spread of the 
disease, we need to see that those who have it take proper care 
of themselves, so that the germs which they are giving off do 
not make their way to some one else. When one is suffering 
from consumption, as you have already learned, the germs are 
given off in the sputum in enormous numbers, and the important 
thing to do is to prevent this sputum from drying. A consump- 




Fig. 17. — A pocket spit cup 
for the use of consump- 
tives. 



tive should never spit on the floor (in fact, no one ever should) 
or any place where the sputum will become dry. A handker- 
chief is perhaps the worst thing that a person could use. It 
is best to have either a spittoon, containing some chemical 
substance that will destroy the bacteria, or, what is better, to 
have little paper cups or napkins, which when they have been 
used, can be burned. If we could kill all the germs in the spu- 
tum of those suffering from, tuberculosis, the disease would im- 
mediately disappear from the world. At least this is the view 
of a great many scientists. The legend, so frequently seen in 
tuberculosis literature, no spit, no tuberculosis, voices this 
idea, and is largely if not entirely true. 



Simple Lessons on Causes and Prevention. 



27 



It is possible for the germs of tuberculosis to be transmitted 
from cows to human beings, particularly children, through the 
milk. This is generally admitted. In order not to get the 
disease by drinking milk, it is necessary that all the milk sold 
on the market or used in the home, should be from cattle known 
to be free from tuberculosis. Fortunately, it is possible readily 
to test cattle for tuberculosis by means of what is known as the 
"tuberculin test." This test does not cost much, is easily used, 
and is very accurate. Farmers are finding that it paj T s to have 
all their cattle tested, because tuberculosis in cattle is as "catch- 
ing" among cattle as it is among men, and perhaps more so. 
If the disease once gets into a herd, it will be sure to spread 
and, in the long run, produce the worst results unless it is 
promptly checked. 

Flies sometimes help to spread this disease. No one knows 
the proportion of cases that they cause, but it is very important 
that food should be kept away from flies. This ought to be 
done by trying first of all to limit the number of flies produced. 




Fig. 18. — A fly on a piece of sponge cake. He 
probably came quite direct from unmention- 
able filth in the neighborhood to the dining 
room. Published in Country Life in America. 

This can be done by caring for manure, garbage, etc., in such a 
way that the flies cannot breed in these materials. Secondly, 
we should screen our houses, and keep flies out of the kitchen 
and the dining room, particularly. In addition to this, we 
should take especial care to protect all food from the flies by 



28 



Tuberculosis: or The Great White Plague. 













I2~ J& 



19 J}$%^ 







Pig. 19. — Fly tracks on "sterile culture media." These 
covered glass dishes were first made sterile, or germ 
free, by high heat. When they were cool there was 
poured into them a thin layer of sterile gelatin, which 
soon hardened. 

A fly was first allowed to walk on material contain- 
ing a great many bacteria and thus get its feet dirty. 
It was then taken and put into these dishes and urged 
to walk around in them each in turn, twenty in all. 
Only eleven of the twenty are shown but the others 
are practically the same. These dishes were then in- 
cubated for forty-eight hours. The bacteria left on 
the gelatin by the fly's feet had in this time multiplied 
to such an extent that the tracks were visible to the 
naked eye, and appeared as shown in the photograph 
above. The fly was killed and the number of bac- 
teria left on its feet and those swallowed was then 
determined, as shown in the dish in the lower right 
hand corner. 

It was found that this particular fly had enough 
bacteria left on it, after walking over all of the above 
dishes, so that every man, woman and child in the 
United States could have one apiece, i. e., there were 
90,000,000 bacteria left. — Original. 



Simple Lessons on Causes and Prevention. 



29 



screening shelves or other places for storing food. The flies 
carry on their feet the tuberculosis germ from sputum on the 
street, or in the gutter, or elsewhere. As they walk over the 
food they leave these germs, sometimes in very large numbers, 
and the disease is spread. They also carry typhoid fever germs 
and spread them. In fact, the common house fly is now knoAvn 
as the "typhoid fly". 

One very rarely gets tuberculosis out-of-doors, but almost 
always in the house, or in the workshop. Hence, it is of the 
very greatest importance to have houses and workshops most 
carefully "disinfected" when people having consumption are 
present, and especially when they leave. Where people having 
consumption occupy buildings and are careless, these buildings 
become real tuberculosis nests, or breeding places. It is a mat- 
ter of extreme importance, therefore, when one moves into a 
house which other people have lived in, to find out whether the 
disease existed there, and if it did to have the house properly 
disinfected before going into it. This is a matter ivhich must 
never be overlooked, and no one having a family in his or her 
care should move into an infected house until it has teen prop- 
erly prepared, by being most thoroughly cleaned and disinfected. 




Fig. 20. 



30 



Tuberculosis: or The Great White Plague. 



Lesson IX. MEANS OF PREVENTING TUBERCULOSIS 
» (Concluded) 



f*s:¥ 



In the last lesson on the prevention of tuberculosis, the em- 
phasis was placed on the need of destruction of the germs that 
leave the sick person, and the protection of the "portals of 
entry" (the mouth and nostrils mainly) to the bodies of those 
who are well. Another very important part of the work of 
prevention is the development and maintenance of the normal 
or natural vigor of the body, or the conservation of the "health 
tone." The person who is in ill health, or in a state of low 
vitality for whatever cause, is much more liable to be attacked 

by tuberculosis, as well as by 
other diseases, than is a per- 
son in good health and vigor. 
Among the things which may 
be considered as helping to 
cause tuberculosis are certain 
kinds of work, overcrowding 
in homes, schools, workshops, 
etc., because of poor ventila- 
tion, unhealthful conditions, 
dust, and bad housing for 
these lower the health tone. 

The frequency of tubercu- 
losis among people of differ- 
ent occupations has been 
worked out. Laborers and 
servants head the list, while 
farmers and other outdoor 
workers are lowest in the list. 
Where one is free to choose his own work, it is worth while, 
before he makes a selection, to consider the relative healthful- 
ness of various occupations. It seems probable that many kinds 
of work can be made less dangerous than they are now. The 
chief reason why it has not been done in the past is because 
the importance of preventing disease has not been realized. 
The young people who are growing up should and will un- 
doubtedly do much in this direction. It is not merely a ques- 
tion of indoor and outdoor occupation, for some of the outdoor 




(HONEST DOCTOR 
FRESH AIR 
'GOOD FOOD 

SUNLIGHT-REST 
PLUCK 



•^■tf-^fciS&ss- 



Fig. 21. 



Simple Lessons on Causes and Prevention. 31 

occupations have 1 a marked influence in producing ill health. 
The accompanying figure will show that the percentage of tu- 
berculosis among quarrymen is higher than it is among many 
indoor workers. Why? 

Overcrowding in houses helps to make people more likely to 
have diseases, especially tuberculosis. If we should count up the 
number of people who live in one-room apartments^ compare'! 
with the number who live in apartments of two, three, four, or 
more rooms, we should find that there are not so very many ; 
but if we should compare the amount of sickness and death 
among those in the single-room apartments with the amount 
among those who have more room, we should find that the per- 
centage of sickness and death would be very much greater ; and 
anyone who is obliged to live in crowded quarters, in either the 
home or the workshop, is taking a much greater risk of contract- 
ing disease than the people who have more space. Many people 
who could have plenty of room if they wanted it coop themselves 
up in cramped quarters for the sake of convenience, or to keep 
warm. If they would use their larger space, exercise more, and 
if necessary, spend a little more money on fuel, they would be 
much better off. 

The lack of fresh, pure air in the house or the workroom, 
or the schoolroom keeps people in such a "run down" state 
that they are not the best workers and are likely to take diseases. 
Far too many buildings are without good light and proper mean; 
of ventilation. In olden times, methods of constructing houses 
were much inferior to the present, and on this account build- 
ings were far less tight than they are today. And then, too. 
the method of heating was at one time almost entirely by 
means of open fireplaces. Under these conditions, special 
means of ventilation were not needed as they are at the present 
time, with our tight buildings and our steam and hot water 
plants. All buildings, where a number of people are working, 
should be provided with special means for bringing in pure 
air. The constant change of air in an ordinary living room, 
(called ventilation.) may take place by natural means, but in 
larger rooms and buildings, where there are a good many peo- 
ple, mechanical means should be employed to change the air 
forcibly. This can be done by the use of fans which drive 
pure air into, or which draw the impure air out of, a room. 
In some buildings both systems, forcing in and drawing out, 



32 T uberculosis : or The Great White Plague. 

are used. Public buildings, such, as factories, (workshops, 
stores, and schoolhouses, as well as private homes, should in 
these days be built around a good ventilating system, as they 
were formerly built around the chimney. In case buildings 
must be used without special means of ventilation, a great deal 
may be done by bringing pure air in constantly through the 
windows or other openings. 

In order to secure a constant supply of fresh air, it is nec- 
essary to train the sense of smell so that it will detect impure 
air. We are likely to grow careless in regard to this ; but any- 
one who understands the importance of pure air may after a 
while become so sensitive to bad air that he will be uncomfort- 
able in it. We sometimes think of this latter sort ol person as a 
"crank," but in reality he is very wise, and we ought to do as 
he does and demand pure air for our lungs, as we now demand 
pure food for our stomachs, and clean clothes for our bodies. 

Our houses are too frequently in an unhealthful condition, 
due to the lack of proper cleaning. This sometimes occurs be- 
cause people who have charge of a home have not been brought 
up to appreciate that cleanliness is next to godliness, and im- 
mensely important. But it is probable that such persons are 
comparatively few. Most people would like to keep their 
houses clean, but on account of conditions beyond their con- 
trol, many have scarcely the time or strength for it. We can 
overcome these difficulties only by helping to change the social 
conditions for such people ; and if we are true friends and 
neighbors we can do a great deal more than might at first be 
thought possible. 

Our ways of cleaning are not all so good as they might be. 
For instance, in sweeping with a dry broom we stir up a good 
deal of dirt from its hiding places; much of this dirt merely 
gets into the air in the right form to breathe. It is perhaps 
true to say that dry sweeping, instead of making a place more 
healthful really makes it more dangerous. The same thing is 
true in regard to methods of dry dusting. The feather duster, 
or the dry dustcloth which is shaken in the room, is a very 
good way of getting dust into the air, and of not getting rid ot: 
it properly. 

The best way to clean is with a good "vacuum cleaner." By 
this means all of the dirt is taken out of the house without stir- 
ring up dust. There are, however, some of the cheaper cleaners 



Simple Lessons on Causes and Prevention. 33 

which throw the dirt back into the room, and these, like the 
broom, must be considered as enemies of health. Where vacuum 
cleaners are not possible, a carpet sweeper may be used, or some- 
thing may be put on the floor, such as wet strips of paper, tea 
leaves, or some of the prepared "dust-layers." For dusting, 
special cloths may be bought or prepared which hold the dirt, or 
a damp cloth may be used. 

Many houses are built over damp and dirty cellars. There 
is no excuse for a dirty cellar. If only one place in the house 
can be clean, it should be the cellar. Let the parlor go dirty, 
if you must, but clean the cellar. Too often the cellars and 
halls in apartment houses are not properly cleaned, because no 
one person has complete control of them. They are neglected 
on the principle of "Everyone's business is nobody's business." 
Damp cellars are very generally regarded as unhealthful. Few 
landlords would be willing to live over damp cellars themselves, 
and no landlord ought to be permitted to allow his tenants to 
live in such surroundings. In these days when cement is so 
cheap and so generally used, there seems no excuse for it. 
What we need is merely an aroused public opinion. 

Sometimes houses are well kept inside, but have dirty and 
unsanitary back yards. The back yard ought to be as clean as 
the front yard, and some means of taking care of the necessary 
refuse about any building should be provided. The method of 
hanging bags so that they can be readily filled with old paper, 
and tin cans is excellent. Garbage should also be carefully taken 
care of. In the city where it is collected it is important to have 
cans or boxes for it properly protected from flies. Where the 
garbage must be cared for on the place, this can be done by 
burying it or burning it. 

Another thing that should be especially attended to about the 
house, or any building for that matter, and perhaps especially 
the school, is the plumbing. Defective plumbing allows the es- 
cape of gases and odors into the room and these are generally 
considered to be important means of lowering the "health tone." 

In considering matters of this kind, it is worth calling to 
mind the words of Longfellow in his "Builders:" 
"In the elder days of Art, 

guilders wrought with greatest care 
Each minute and unseen part; 
For the Gods see everywhere. 



34 



Tuberculosis: or The Great White Plague. 



Let us do our work as well, 
Both the unseen and the seen; 

Make the house where Gods may dwell, 
Beautiful, entire, and elean. " 




Fig. 22. — A dust storm. May disease 

germs be spread by such storms? 

How? Will oiling streets prevent 
this? 



Dust, either inside or outside of the house or school building, 
when breathed into the lungs, is harmful. It undoubtedly is 
the cause of disease, and especially of diseases of the lungs, 
such as consumption. Some kinds of dust are much more irritat- 
ing, and so more harmful, than others. Metallic dust, especially 
when the particles have sharp, cutting edges, is likely to be Yexy 
injurious; the dust caused in making knives and forks, etc., 
is very bad for the health. Other dusts are not so bad, but 
they may cause serious changes in the lungs. Hard dust, such 
as that produced by working on stone, is likely to be harmful. 
Coal dust acts much in the same way. When these little particles 
of dust are breathed in, they make their way from the air cells 
to certain parts of the lungs, where they gather in large numbers. 
They are carried to these tissues by the white blood corpuscles. 
The effect of the gathering of these particles in the lungs is 
the most easily seen where coal dust is breathed in; and if it 
were possible for us to see the lungs of those who handle coal, 
and those who live in big cities, especially where a great deal 
of soft coal is burned, we should notice that parts of the lungs 
were coal black in color, and in this respect would be very dif- 
ferent from the lungs of a person who had always lived in the 
free, open country. The bad effects of the constant breathing 



Simple Lessons on Causes and Prevention. 



35 



of dust-laden air are easily shown where the death rate from con- 
sumption in different occupations is studied. 

The lighting of a house is a matter of no small importance. 
Houses ought to be so arranged that the sunlight will enter 
through at least one window, in every room during the course 
of the day. Those rooms that are the most used should be 
the best lighted. It is important, then, to build houses with 
reference to the lighting. It is not at all necessary that a 




Fig. 23. — Individual towel distributor in use at the 
University of Wisconsin. The towels are small 
and a fresh one is always ready for use. Why is 
this a good arrangement? 



house should face the street, and many houses are now built 
facing a beautiful outlook. Houses ought always to be faced 
with reference to the sunlight. The size and arrangement of the 
windows should depend upon what is the most healthful and 
not upon what looks best, although it is generally true that 
houses can be suitable to live in and beautiful to look at, at the 
same time. The amount of window space in a room should be at 
least one-fifth of the floor space. 



36 



Tuberculosis: or The Great White Plague. 




Fig. 24. — A sanitary bubble drinking 
fountain. Is this better than usin; 
a common drinking cup? Why? 



The necessity for light in 
bnildings was .realized long 
before the real reason was 
discovered. There is an 
Italian proverb that says, 
' ' Where sunlight do.es not en- 
ter, the physician does. ' ' One 
reason, at least, why this h 
true, is that the sunlight hill ? 
the disease germs. Sunlight 
is, as we say, a good "germi- 
cide," or germ-killer. In 
building a house, the first 
thing to be thought of should 
be the effect which the loca- 
tion and arrangement would 
have upon the health of those 
who are to live in it. It is 
not enough, however, to have 
properly constructed buildings. They must be sensibly used. 
Windows are of little use if the shades are always drawn, or the 
blinds are always closed. A large bedroom or living-room may 
easily be overcrowded. Sometimes people, who have all the 
room they need, live in a little ill-smelling kitchen in the day- 
time, and a stuffy, foul bedroom at night. These people, of 
course, do not realize how bad such a life is for themselves and 
their children. There are many things worse for health than 
being cold — for instance, being overcrowded, and having too 
little pure, fresh air, and bright, life-giving sunshine. 

It is sometimes supposed that these ills which we have been 
talking about are found only in the city, but this is not true. 
Housing conditions are often as bad in the country as they 
are in the city. It is true that in the country there is plenty 
of pure air and bright sunshine, and frequently the houses 
are large enough ; but the people are likely to be overcrowded 
in certain rooms, as the kitchen and sleeping rooms, for short 
periods of time in the summer, and long periods in winter. 
The desire to save money has led people to be careless about 
healthful conditions; and small rooms are frequently built and 
used because they do not require much fuel for heating. This is a 
poor way of saving, as people would readily understand if they 
stopped to think of the matter. The cost of a doctor's bill and 



Simple Lessons on Causes and Prevention. 



37 



perhaps a funeral may easily more than offset the "saving" in 
fuel and sufficient room. 



- : - ■ 

a 






■ 




Fii 



A sanitary drinking fountain is possible wherever 
there is a well. 



THE FENCE OR THE! AMBULANCE. 
'Twas a dangerous cliff, as they freely confessed, 

Though to walk near its crest was so pleasant, 
But over its terrible edge there had slipped 

A Duke and full many a peasant. 
So the people said something would have to be done, 

But their projects did not at all tally. 
Some said, "Put a fence round the edge of the cliff," 

Some, "An ambulance down in the valley." 

But the cry for the ambulance carried the day, 

For it spread through the neighboring city; 
A fence may be useful or not, it is true, 

But each heart was brimful of pity 
For those who slipped over the dangerous cliff; 

And the dwellers in highway and valley 
Gave pound or gave pence, not to put up a fence, 

But an ambulance down in the valley. 

"For the cliff is all right if you're careful," they said, 

"And if folks even slip or are dropping, 
It isn't the slipping that hurts them so much 

As the shock down below when they're stopping." 

Then an old sage remarked: "It's a marvel to me 

That people give far more attention 
To repairing results than to stopping the cause, 

When they'd much better aim at prevention." 

"Let us stop at its source all this mischief," cried he 

"Come, neignoors and friends, let us rally. 
If the cliff we will fence, we might almost dispense 

With the ambulance down in the valley." 
"Oh, he's a fanatic," the others rejoined, 

"Dispense with the ambulance? Never! 
He'd dispense with all charities, too, if he could; 

But, no! We'll protect them forever! 

"Aren't we picking up folks just as fast as they fall? 

And shall this man dictate to us? Shall he? 
Why should people of sense stop to put up a fence 

While their ambulance works in the valley?" 



38 



Tuberculosis: or The Great White Plague. 



Lesson X. DEVELOPING RESISTANCE TO DISEASE. 

One of the most remarkable things in all the world, so the 
seientist thinks, is the fact that certain animals are "resistant," 
or "immune," to a disease, while other animals differing very 
slightly take the disease readily : e. g., the house mouse is im- 
mune to glanders, a disease common among horses, while the 
field mouse is extremely susceptible. The rat is immune to 
many germs which attack his near relatives. Differences of the 
same kind are seen in man. Some races take diseases more 
easily than others ; and everyone knows families that are always 
sick, whose members take every "catching" disease that is 
about ; while other families in the same community are well and 
strong, and almost always escape the ordinary diseases. The 
same thing is true of persons; some people are very suscepti- 
ble to disease, and in later years speak with apparent pride of 
the fact that they have themselves had all of the ordinary dis- 
eases. 

Scientists are not agreed as to the reason for this difference 
between individuals. "Immunity" may be handed down from 
one generation to another in the family. Perhaps, also, a per- 
son may inherit a readiness to "catch" a disease. We do not 
know whether this is true or not, but we do know that surround- 
ings, habits, and even ways of thinking do have a marked influ- 
ence upon the disease resistance or susceptibility of a person. 




Fig. 26. — Plenty of fresh air. 



Fig. 27. — Fresh air at night. "Night 
air is not dangerous unless it be 
last night's air." 



Simple Lessons on Causes and Prevention. 



39 




29. — Healthy exercise. 



Fig. 28. — Even the little fellows enjoy 
the winter hikes. 



In order to escape disease one must have healthful surround- 
ings. This does not mean elegant surroundings. In fact, the 
life of the rich is quite as likely to lead to ill health as the life 
of the very poor. What is really needed is for all of us to 
live a simple, wholesome life ; and it is easily possible for almost 
any one, oven though he be poor, to keep his surroundings so 
healthful that they can not do him any injury. This may neces- 
sitate moving from one house into another ; or changing the rooms 
in one's house, changing the way one divides his time for work 
and play, or the like ; but these things could be done if the neces- 
sity for them were really felt. A good many things necessary to 
be done depend upon many persons doing them together ; but 
first, people have to be shown that such things are necessary. A 
great many people do not know that tuberculosis is a germ dis- 
ease which is "catching" and do not therefore see how necessary 
it is to take care of the sputum, to disinfect, etc. No child is so 
small that he cannot help to teach people to be careful about 
tuberculosis. Children ought to take pride in work of this 
kind, just as they take pride in succeeding in their school work, 
or in their games. 

In order to keep well, one must have plenty of pure air. 
We may speak of this again so as to impress it. Health experts 
are quite agreed now that fresh air is very important in prevent- 
ing tuberculosis as well as pneumonia, and certain less 
fatal diseases, such as influenza (or grippe) and colds. Every- 
one ought to have fresh air in abundance while he sleeps. At 



40 



Tuberculosis: or The Great White Plague. 



the present time evidence seems to point very conclusively to the 
desirability of sleeping out-of-doors. If this cannot be done, 
the bedrooms should have several windows, and they should be 
kept open — fully in mild weather, and sufficiently in cold 
weather to insure the frequent change of air in the room. Dur- 
ing the day, whether at home, in the schoolhouse, or at work, 
everyone ought to insist on a good supply of fresh air. The 
one who does this has an advantage over the one who does not ; 
and the former can resist disease which may attack and con- 
quer the latter. 

In order to keep well one must also have wholesome food, 
properly cooked, regularly eaten, and completely digested. 
Most people can get plenty of good food nowadays; and if 
they do not know how to cook it, there are many ways by which 
they can learn. In most cities there are cooking classes. The 
United States Government also publishes bulletins which are 
of great value. It frequently happens that people suffer from 
sickness caused by bad habits of eating, such as not chewing 
enough, eating too much candy, eating between meals, always 
eating soft foods, and so on. When such sickness is severe, a 
doctor should be consulted. It is better to pay a small fee to 
a doctor who can tell you hew to live than it is to pay him 
later for work done at your bedside. But don't take patent 
medicines, whatever you do. Many people are ailing much of 
the time because they are constantly swallowing patent medi- 
cines. 

If one would escape illness he must be careful of his exercise. 
Children do not usually need to be urged to take exercise, but 
they do need to be warned against too much exercise. There 
is great danger of taking "cold" after violent exercise, and 
children ought early to learn how to protect themselves from 
colds, especially those colds that come from cooling off too 
fast when one has been working or playing very hard. Colds 
do not "just happen;" they have a cause. Colds are often 
caused by the sudden chilling of some part of the body, causing 
the blood which is usually at this part to rush to the nose and 
throat, resulting in a congestion there. 

Colds are also caused by microbes, and such colds are passed 
on from one person to another. One should keep away from 
people suffering from colds, especially colds of a "grippy" na- 
ture. Colds in themselves are not usually considered serious, 



Simple Lessons on Causes and Prevention. 



41 



but when we remember the inconvenience and suffering which 
they produce, and the loss of time and energy which they cause 
we can see that there is hardly anything more important. Be- 
sides this, they have an influence in making people more likely 
to take diseases. We very frequently hear people talk about 
a cold running into this disease or that disease ; but this is 
not true, as tuberculosis, for instance, never comes from a cold, 
and never follows a cold, unless the germ of tuberculosis is pres- 
ent. However, colds sometimes do make people so weak that 
they easily take tuberculosis, as well as other infectious diseases. 

The protection of the body is also a matter of very great 
importance for one's health. A person ought to wear the right 
amount of clothing, suited to the season. Too much is as dan- 
gerous as too little. If one wears too little clothing, the vigor 
of the body is likely to be lessened ; and the same is true if the 
clothing is too thick. Children, especially, are likely to object 
to wearing extra clothing, or "bundling up" even when it is 
absolutely necessary, because it interferes with their movements 
or their convenience. But they must remember that the main- 
tenance of health is the most important thing in the world to 
them, and if they do not preserve their health they will bring- 
upon themselves bodily suffering, and bring to their relatives and 
friends care and anxiety without measure. The necessity for 
this care has been taught by the experience of the race. Why 
do children persist in going out without their rubbers when 
they know that they will get their feet wet? Why do they re- 
fuse to wear an overcoat or mittens which they need? 

One should get into the habit of looking out for his health; 
in order to do this he ought to consider the following rules: 




Fig. 30. — Girls as well as boys need Fig. 31. — Little children love the "out- 
the "out-of-door"' exercise. of-doors." It is their best friend. 



42 



Tuberculosis: or The Great White 1 v lague. 



RULES OF HEALTH. * 

1. When you arise in the morning throw the bedding over 
the foot of the bed so that the bedclothes may have a chance 
to air. 

2. Close the window that has been open during the night if 
you are to dress in the same room. Otherwise it is not neces- 
sary. 

3. Cleanse the teeth, especially the places that are out of 
sight and hard to reach. 

4. If you have time, bathe all over (finishing, if not begin- 
ning, with cold water). If it is not possible to bathe all over, 
bathe the face, neck, and chest, and particularly the eyes, ears 
and nose. 

5. Clean the finger nails. This should become a fixed habit. 

6. Drink a glass of water. This is a good habit to form, and 
it seems to aid digestion. 

7. Eat breakfast at a regular hour. Eat only what agrees 
with you. Make an effort to be cheerful at meals. 

8. Visit the toilet, if practicable, at home. Have some reg- 
ular time during the day. 

9. Spend as much time in the open air as possible. Create 
an interest in nature. Make friends with sky, birds, flowers, 
trees and animals, and be attentive and true to them. 

10. Be punctual in all of your duties both in and out of 
school. 

11. Try to have a supply of fresh air wherever you are, and 
demand this with the same emphasis that you use in demanding 
sufficient heat in cold weather. Do not be afraid to say: "I 
need fresh air." 



* Adapted from Allen in "Civics and Health." 




Fi°\ 32. — Dry feet, fresh air, and plenty 
of sleep help to keep up the power 
of the body to kill germs. From 
Ritchie's Hygiene published bv the 
World Pub. Co. 



Simple Lessons on Causes and Prevention. 43 

12. Eat punctually at noon. Take time and enjoy your meal 
and its effects. 

13. Breathe air out-of-doors as long as possible, in walking 
and playing lightly. 

14. Resume your duties punctually. 

15. Stop work regularly and promptly. 

16. Take out-of-door exercise — indoor, only when fresh air 
is possible — that you enjoy and which agrees with you. If you 
get "sweaty" in playing, — when you stop put on extra clothes 
or go into the house. Do not court a cold. 

Be especially careful to keep your feet dry. If you cannot 
help getting them wet, make every effort to change your 
footwear or to dry it out promptly. To take care of yourself and 
preserve your health is most important. It is not a cowardly 
thing to do. It is the most important and manly or womanly 
thing you can possibly do. 

17. Eat your evening meal at a fixed time, and do not hurry 
with it nor eat too much; eat nothing that disagrees with you. 

18. Spend the evening pleasantly in ways that are in keep- 
ing with the foregoing habits. 

19. Go to bed regularly at a fixed hour; make up for any ir- 
regularity one night by an earlier hour the next night. 

20. 21, 22. Repeat 4, 6, 8. 

23. Turn your underclothes wrong side out for ventilation. 

24. Open the windows, or sleep out-of-doors if possible. 

25. Relax your mind and body and go to sleep. 
Suggestions for some practical work are here proposed. 

A grown-up person requires about three thousand cubic feet 
of air every hour. "When the necessary ventilation is secured, 
the required cubic contents can be reduced to two thousand 
cubic feet or less. In most homes forced ventilation is not 
provided for. Figure out the number of cubic feet in your liv 
ing room and divide it by the number of persons who are us- 
ually there. Do you have the required amount of air in your 
living room? 

In the same way find out the air space in your bedroom, and 
the amount of air for each person in it. 

Do you sleep with your bedroom window open ? How wide ?* 



*The teacher should 1 be careful not to make public comparisons 
which will hurt the feelngs of sensitive children whose home' condi- 
tions are poor because of poverty, sickness, or the like. 



44 



Tuberculosis: or The Great White Plague. 



Since a room ought to have window space equal to one-fifth of 
the floor space. Find out the size of the floor in your living 
room and then determine the area of the window space. Have 
you as much light as you ought to have? Do the same thing 
for your bedroom. 

Does the sun shine directly 
into your living room and 
bedroom? For how many 
hours every day? 

How much space i s there 
between your own and your 
neighbor's house? 

Does the teacher keep the 
window curtains drawn down 
over the top part of the win- 
dow? Unless the sun is shin- 
ing into the room through the 
window, the curtains should 
be rolled up to the top. The 
room is lighted mainly from 
the upper part of the win- 
dow. If you get water for 
school uses from a well, is the 
well carefully pumped out 
and cleaned before school be- 
gins in the fall? It should 
be covered so that dirty water cannot possibly run into it, and 
so that mice and other small animals cannot fall into it. 

School authorities should provide seats in the schoolroom 
suited to the size of the children, so their feet rest on the floor, 
and so they do not have to stoop over when they sit at the desk, 
or twist themselves out of shape because the desk is too high. 
In other words have the seat, desk and child properly matched. 

If you live in the country, has the school a ventilating stove 
that brings in fresh air? Is there an outlet for bad air? If 
not, why not? 













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Fisr. 33. — A hike through the woods 
There is plenty of fresh air here. 



Simple Lessons on Causes and Prevention. 



45 



Lesson XL TUBERCULOSIS A CURABLE DISEASE. 



Our ideas of the possibility of curing tuberculosis have been 
changed a good deal in the last few years. People once be- 
lieved that tuberculosis was incurable ; and to tell a person that 
he was afflicted with the dread malady was like reading his death 
warrant to him. Today we look upon the disease in quite a 
different light. It is curable. This change in our views has 
not come about, however, because of the discovery of some new 




Fig. 34. — Out-of-door school for tubercular children — fresh air — open minds. 

medicine, for it still remains true that we do not know of any 
specific for this disease. Quacks and patent medicines cause 
much real suffering, because victims are made to think that 
they can be helped by some skillfully advertised medicine or 
"cure," which is really not going to give the expected relief, 
but which is almost certain to delay honest and helpful treat- 
ment until the case is beyond help. Remember that the mod- 
ern treatment of tuberculosis requires open air, rest, and food. 
It would be difficult to explain just why it is that out-of- 
door air is better than the air of dwellings, but there is abun- 



46 



Tuberculosis: or The Great White Plague. 



dant evidence to show that this is true. A tubercular patient 
should be in the open air practically all of the time, day and 
night, summer and winter. That cold air is not harmful, but in 
reality helpful, is shown by a saying in the Adirondacks, gen- 
erally accepted as true, that "One winter is worth two sum- 
mers." Are you in as good health in winter as in summer? 
Whatever your answer is, say why. Where and what are the 
Adircndacks ? 

Another necessary requirement is rest. When there is fever, 
especially, it is absolutely necessary that there should be rest, 
complete rest, and to this end the patient must occupy the bed 
and lounging chair constantly. The slight amount of exercise 
necessary must be taken a little at a time, so as not to overtax 
the strength. It is quite impossible for tubercular patients to 
work hard and at the same time take the proper care of them- 
selves. The third thing necessary is plenty of food, especially 
proteid food, such as meat, eggs and milk. 

Climate is not now considered a very important matter in the 
treatment of tuberculosis. By this is meant that tuberculosis 
can be cured in almost all climates, and many persons cannot 
afford to go to some other climate. It seems best, therefore, to 




Fig. 



5. — A Sanatorium for the treatment of tuberculosis. Here the patients 
have fresh air day and night. 



Simple Lessons on Causes and Prevention 



47 



treat tuberculosis at home or in "sanatcriums" close by. Note 
the arrangements for treatment in the accompanying pictures 
of sanatoriums. 

The cure for tuberculosis is really only a healthful way cf 
living, and the more nearly one holds himself to the rules the 
better are the chances for recovery. This is borne out by the 
fact that patients in prisons make the highest percentage of re- 
coveries, soldiers next, and persons in ordinary life last of all. 
Why, do you think? 

Look up in the dictionary the meaning of the words sanitarium 
and sanatorium. 

Where is the Wisconsin State Sanatorium for tuberculosis? 

Tell what railroads, or other means of conveyance, you would 
have to take to get there, and what the probable cost would be. 

Do you know anyone who has ever been there? If so, get 
him to tell you about the life there. 

If you sleep out-of-doors, tell how the bed is arranged and 
the amount of clothing which you use. If you do not now 
sleep out-of-doors find out the best way to arrange for doing it. 
Find out the amount of bedding which you would need. What 
would be the cost of a tent in which you might sleep all sum- 
mer?* 



* Te?.chers might find, it profitable to have a little exhibit illus- 
trating tuberculosis or hygiene. Miss Goldie Whipple, of Superior,. 
Wisconsin, prepared such an exhibit which was sent to the Interna- 
tional Congress on Tuberculosis at Washington smd attracted wide 
attention. 

Boys could be asked to make a model of a sanitary tent with floor 
ard means of ventilation. Girls could make a small model of a 
sleeping bed or a hood and dress up a doll to show the way the 
clothes should be arranged for out-door sleeping. 

Charts could be prepared and pictures from bulletins mounted so 
as to make a very creditable showing. They could be arranged to 
show that tuberculosis is a communicable, a preventable, and a cur- 
able disease. 




Comforters 

jjgjg -Blankets 
«****» i Cotton 
1 sheets 



—Bed pad 
' — Second mattress or 
1 — Paper [blankets 
sheets 

—Mattress 




-Springs 



Fiir. 36 — Thib shows bow a bed should be ra-ade up 
' for out-of-door use. 



48 Tuberculosis: or The Great White Plague. 




Fig. 37. — This little family is ready for bed. 



LB '12 



